Provider First Line Business Practice Location Address:
7617 LOUISE AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91325-4523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-705-6969
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/23/2008